When is a Tablet PC Not a Tablet PC?
This morning I spent five hours at the doctor’s office having some routine tests, and it gave me the opportunity to observe how the practice is run. My doctor is a very tech-savvy guy, and he uses a Fujitsu Lifebook convertible notebook in the office. I observed him going all over his office with the Lifebook in hand, and it was common to see him standing with the Lifebook sitting on a counter in front of him typing away. The problem with that picture is the Fujitsu is a fine Tablet PC, yet he uses it as a notebook all the time.
I spoke to him about it, as he is familiar with my work here; in fact, he pointed out to me that my from-the-heart chronicle in which he is mentioned is in the top 10 results he gets when he googles his own name. I asked him why he doesn’t use the Fujitsu as a Tablet PC, and he actually got sad when he responded. He likes the Tablet PC and enjoys using one with the pen, which makes a great deal of sense, given how he works on his feet and is constantly on the move. The problem he has doing that is the special software that runs his medical practice, while written for the Tablet PC, is not easily user modifiable. The software uses templates for all of the modules provided, and those templates do not fit the way his practice works for using the Tablet PC.
This really irks him, as he specifically chose a software package (I don’t know which one) for use with the Tablet PC. He told me that in the beginning he spent a lot of wasted time trying to use the software templates with the Tablet, and he eventually had to give up as it wasn’t practical. He gets annoyed every day that he is using the convertible strictly as a notebook due to these templates. He said that maybe someday he will spend big bucks to hire a programmer to modify the entire system, but if he does that, then he opens himself up to having to provide his own support for the modified software. I suspect this happens more than I realize, and it helps explain why the Tablet PC may not be used even in vertical markets that are a good fit for the technology.
sounds like he needs some help from the likes of Loren Heiny, Josh Einstein, or Fritz Switzer. In fact, I think Fritz specializes in the medical field and is in Texas.
Same thing happened at my recent doctor’s appointment, right down to the Fujitsu Lifebook being used as a laptop. Said he just wasn’t big on the pen, although all he really did on it was scroll through my data.
At the hospital I work at now, we’ve got 5 HP 2730P’s that we’re using to test out how the Tablet works in our environment and with our applications. So far all is good, but nothing is really designed for tablets either, so a lot of time is spent with the TIP and just clicking “Insert” to dump things into text fields.
I’m really hoping to spend the summer addressing that, and I will certainly keep an eye out for this type of issue.
I am a family doc. My office has been using tablets and a tablet based EMR for 8 years. I used a slate up until last year. We moved in to a new office that we designed and we put small desk/counter areas because we were tired of typing/scribing on our laps. Since with have mini desksin each room I went for the Lenovo x61 because sometimes typing is fasting then using the TIP. We have to use XP Tablet Edition as our EMR doesn’t run on Vista. We are moving to a new modern EMR (e-MDs) in a few months that should run on Vista or Windows 7. I will definitely use the handwriting at that point. I found XP to be too inconsistent with handwriting (despite a medical dictionary). I needed to go back and edit my text too much. I will sit there using pen/touch screen/keyboard/Lenovo mouse nipple thing during the visit. My patients can’t believe all the ways to interact with the machine. (at one point I had Dragon on there too be the array mic was not accurate enough).
I have made great use of Stroke-IT and Phraseexpress to make very powerful macros using simple penstrokes. It has greatly sped up my documentation and made it much more complete.
I would encourage everyone to look at Stroke-It and Phraseexpress. They are a great combo. A few minutes spent setting up some macros has really improve the quality of my documentation.
A 5 hour doctors appointment? Holy cow!
This problem has been going on since the early 90’s, when nascent pen computing companies were trying to sell pen tablets to the medical industry. Hardly anybody that is the target market for pen-based systems has a decent in-house IT department, or budget to hire consultants. The market is too fragmented for standard solutions, and the customers don’t know enough about computers to specify and manage development of custom solutions.
Perhaps what they need is something like Salesforce.com for the medical field. But then Salesforce is heavily reliant on consultant companies to patch up their shortcomings.
When the ROI gets clear enough it will happen – if it’s just a matter of getting rid of paper for the sake of futurism, well, we’re all still waiting for that.
I agree Fritz over at the One Note Toolkit write a good program for use for a small practice in One Note.
E-MDs is a good system for tablets too. They encourage their clients to use them, so in good company there. Some EMRs don’t do that.
The microphones do make a difference, I use my arrays but it’s not medical and I use Vista dictation and Dragon too. Here’s a humorous link I posted today at the blog, you have to love the song!
http://ducknetweb.blogspot.com/2009/05/managed-care-blues-band-might-as-well.html
Also, the tablet is not dead as Microsoft Life Sciences has a tablet project for research they are working on. I just posted an interview with them today on the blog, but on the interview I was not able to cram the tablet in there as it covered a lot of ground, but you can go to the links on the site and read about it from the post.
http://ducknetweb.blogspot.com/2009/05/deep-dive-into-microsoft-life-sciences.html
Hopefully the doctors will see some genuine stimulus money too. They have a lot of different folks pulling them in different directions with everyone trying to tell them what to do. Lots of new devices springing out in healthcare too, a blue tooth inhaler for one, so you can sync it back to your tablet soon:) I somewhat follow a lot of the medical devices and some are almost scary that I post about too.
Missing the elephant in the room!
The problem with medical IT isn’t that they don’t have tablet PCs. The problem is that they all have different systems. These systems can’t communicate, so information about a given patient is not known when he goes to another medical center; they don’t store data in the same way, so information can’t be analyzed for medical research. And least important but probably annoying for doctors, they involve poor non-standard software for the user which hasn’t benefited from returns to scale.
I don’t know if this has been seen stateside yet but
http://blog.tabletpc.com.au/2009/05/12/ballarat-nurses-use-tablet-pcs-for-home-visits/
found this an interesting post hg tabletpc.com.au
This may be largely a vendor/software issue. The EMR I am currently using allows me to use pen input quite efficiently for data entry, prescription writing, etc. My convertible tablet stays in tablet mode most of the time.
So is there a brand name?
My doctors, dentist, etc., have seen me working on my tablets for years, but I don’t know enough about tablet-friendly software to make a recommendation, and a couple of them have specifically asked me.
There are many good software programs out there. Active Inking has recently released a EMR that includes inking and they have been components of other larger EMRs for years. There is one for MDs too.
http://ducknetweb.blogspot.com/2009/04/tablet-pc-software-application-for.html
On the Dental side, that’s another issue and I’m not as up to date on that side. Visit Dr. Fishman here too:
http://ducknetweb.blogspot.com/2009/05/best-emrs-for-small-practices-from.html
I got my first Tablet PC (Acer) a couple of weeks before Microsoft officially introduced them and showed it at the Family Practice Convention in San Diego in October 2002 at their EMR session and suggested vendors needed to support this technology and so I agree it is mainly a vendor issue. My following letter was also published in Family Practice Management:
More tips for tablets
To the Editor:
I was very pleased to see your article, “An Introduction to Tablet PCs” [October 2004, page 36]. I have been using them in my office for the past two years. Your article didn’t mention what is in my opinion their most useful feature: The pen is much faster than a mouse or touch pad. I mainly use convertible tablets with keyboards. I type while holding the pen under my index finger and over my thumb and middle finger, with the tip pointed at the screen. This way it is very easy to move the pointer/cursor to the exact spot I need to select or type in. I also use the button on the pen to right-click, which especially helps with cutting and pasting. I have even gotten pretty good at pointing and selecting with my right hand while using my left hand to type short numbers or letters or to erase with the backspace key. The pen is much faster than any other pointing device, especially with software optimized for its use. If we really want more physicians to use electronic medical records, both they and the vendors need to know about this new technology.
I gather from the replies to date that there exists no well suppoerted medical software that makes use of the tablet or slate interface? I believe this is crucial in a patient encounter as typing, however efficient it may be at a desk, is not a practical alternative as we look to transition from bedside paper systems like templates to a real time EMR.
In my own limited experience I was an early adopter of Palm devices and notebooks. A year ago I added an HP 1000tx which I found to be rather underwhelming as both a mobile device (heavy, hot and limited battery life) and a tablet. Recent improvements have included a Wacom interface but, alas, the AMD cpu (‘heater’) remains. Preceeding this I had a brief unpleasant experience with a Avertec convertable notebook. Bear with me here.
Software advances are dependent on hardware technologes. Given that the consumer hardware I’ve experienced is limiting I’m not surprised. But perhaps I have not cast a wide enough net?
John Small, MD
Emergency Medicine
– posted with some difficulty from a Palm Pre
Another issue is the people designing / devloping the software aren’t always up to date on how the industry works. Add to that the fact that these users do not use the software they are developing makes it even more kludgy.